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<form name='frm_25fat'
	action="page_principale.php?form=<?php echo $_SESSION['form']; ?>&amp;from=25fat#annexes"
	method='post'>

	<table class='principale'>
		<tr>
			<td><h2>ANNEX 4: 25 feet ambulatory test &#40;from the Friedreich
					Ataxia Rating Scale&#41;</h2></td>
		</tr>


		<tr>
			<td><br> <b>To test gait, place markers 25 feet apart in hallway with
					no furniture within reach of 1 m/3 ft. and no loose carpet. Patient
					walks 7.62 m/25 ft at normal pace, turns around using single step
					pivot and return to start. The activity is timed. Note if the gait
					was achieved with or without helping device and serial examinations
					should be done with the same device as in the first examination. <br />Helping
					device
			</b></td>
		</tr>
		<tr>
			<td><label><input type="radio" name="help" value="no" /> No </label></td>
		
		
		<tr>
			<td><label><input type="radio" name="help" value="yes" /> Yes </label></td>
		</tr>
		<tr>
			<td><textarea cols="40" rows="4" name="describe" value="">Describe</textarea></td>
		</tr>
		<tr>
			<td><b> Time: <input type="text" style="width: 50px;"
					name="score_25FAT" value="" /> sec
			</b></td>
		</tr>

		<tr>
			<td colspan="2"><input type='submit' value='Submit' /></td>
			</td>
		</tr>
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</form>

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